Talk:Atopic dermatitis

Rewrite of Causes Section Required

I read this page out of interest after a patient decided they were an expert on Eczema after reading this Wikipedia article. I found a lot of factual errors in the article no doubt contributing to the widespread misconceptions about the causes of eczema.

• Food & allergy is considered to play a minor role in eczema. If it was as simple as a dairy (or other food) allergy and excluding it from the diet, eczema would disappear overnight and I would be out of a job.
• Allergy testing is not routinely recommended in clinical practice for a number of reasons. These include the fact that allergy plays a minor role, allergy tests (eg RAST and skin prick testing) are unreliable with low sensitivity and specificity. If a patient is allergic to a food they should be able tell you so from their experiences without the need for useless testing.
• There is (almost) a complete lack of discussion about the role of bacterial colonisation with Staphylococcus aureus.
• Climate
• I could go on and on.

Perhaps the editors for this page should have a thorough read of: http://dermnetnz.org/dermatitis/atopic-causes.html (and associated pages) which presents a more accurate view of the causes of eczema. It is written and edited by expert dermatologists. —Preceding unsigned comment added by 121.98.223.127 (talk) 11:42, 20 January 2011 (UTC)

Removing

Removing the nonsense about psyche and emotions barring a scholarly cite beyond Sontag, who was talking about popular culture reacting to disease, and not disease reacting to popular culture.

Atopic dermatitis is a subtype of eczema

also, it is NOT the same as a candida infection... if there is a relationship, then the previous author needs to provide a scholarly citation See: http://www.niams.nih.gov/hi/topics/dermatitis/

Please merge with "neurodermatitis"

"neurodermatitis" should definitely be subsumed by "atopic dermatitis". AFAIK the latter (or equivalently, "atopic eczema") is now the preferred term.

You are absolutely right! The leading German Handbook of dermatology names the disease "Atopische Dermatitis" (German), in English this is "atopic dermatitis", and names one synonym "Neurodermitis" (German), in English this is "Neurodermatitis". -- Kind Regards, -- Paunaro 20:07, 26 September 2006 (UTC)

do not merge

1. regarding the merge with atopy: not a good idea, IMO, since atopic eczema is not the same thing as atopy, and the main eczema entry needs to be able to point to entries on each type.

2. regarding the merge with neurodermatitis: I argue against. There is some confusion on this issue, since in central Europe atopic eczema seems to be referred to -- some of the time -- as disseminated neurodermatitis. In the English speaking countries (and others?), however, neurodermatitis (or localized neurodermatitis) refers to lichen simplex chronicus and prurigo nodularis, eczemas either self-inflicted or of unknown etiology, but quite distinct from atopic dermatitis.

I think the entry on neurodermatitis should be returned to the original lichen simplex chronicus that has been overwritten with atopic stuff. V.B. 05:06, 9 October 2006 (UTC)V.B.

do not merge with atopy, they are distinct. --Coroebus 19:21, 30 October 2006 (UTC)

oh yeah, and do not merge with neurodermatitis either, as per VB atopic dermatitis and neurodermatitis are distinct (at least in the UK) --Coroebus 20:19, 15 November 2006 (UTC)

Totally agree. Atopy is an immunologic state; atopic dermatitis is a form of eczema. Do not merge.

• Do not merge with atopy. Atopy is the systemic over-production of IgE whereas atopic dermatitis is specifically a disease of the skin. Other diseases that have a component of atopy/allergy (asthma/rhinitis/hayfever etc.) should also be dealt with separately. Atopic diseases manifest at specific anatomical sites, atopy is instead systemic and arguably not a disease in its own right.Yendor 18:39, 21 December 2006 (UTC)

• I do not think that Atopy should be merged with Atopic Dermatitis for the reasons above. Atopic Dermatitis is a specific form of Atopy, while Atopy is a more general condition including other specific forms, such as allergic conjunctivitis, allergic rhinitis and asthma.

Dont merge with atopy because as already mentioned atopy is a immune state rather than a disease in its self. Also the current trend in research is to actually group it with other inflammatory diseases such as crohns disease and leprosy, this is because of research into the role of barrier function in these diseases. Moreover as already mentioned atopy is defined as over production of IgE, well in 20-30% of cases of AD there is no IgE overproduction.

atopisches ekzem

If you look up this entry on German Wiki, you will find that the neurodermitis term is the old one that is being superceded. However, it seems in common usage still. 170.215.67.24 05:26, 9 October 2006 (UTC)V.B.

disambiguation

I created a disambiguation page in reference to neurodermatitis, directing folks to either lichen/prurigo, or to atopic eczema. 170.215.67.24 22:53, 14 October 2006 (UTC)V.B.

not NPOV

"Although many people are intimidated by the term 'steroids,' their proper use can result in atopic dermatitis being brought under control."
This statement is not NPOV, and tends towards the irresponsible. Yes, strong steroids will superficially "cure" most skin problems. But there are also serious risks of systemic side-effects. It is important to use these drugs with care, and only use the minimum necessary, for a minimum time, to get the needed results.

• Citation needed ;). Yes there is a theoretical risk of systemic side-effects to topical steroids, however I would not call it a serious risk as it is exceedingly rare (Rook's Textbook of Dermatology, 8th Edition, 2010. Chapter 73, Section 4).
• Also steroids do not cure most skin problems. There are over 3000 skin conditions. It is inconceivable that topical steroids would even have an effect on more than 50% let alone "cure" them. For the conditions that do respond to topical steroids, most are simply managed or controlled rather than cured with topical steroids.
• For the above reasons I suspect that it is you that is not being neutral and risks irresponsibility.
• Also the focus should not be about trying to be neutral but rather being evidenced based.
• Most dermatologists will probably agree that a major problem in clinical practice is that patients have an irrational fear of topical steroids and fail to use enough of them. This is perpetuated by idiots running around virtually telling people they will die from their topical steroids. This leads to poor control and earlier introduction of systemic immunosuppressants such as methotrexate, azathioprine and ciclosporin. I'm sure you can figure out which has a more serious risk of systemic side-effects. (PS. no I don't have a citation for this as it should be self explanatory). —Preceding unsigned comment added by 121.98.223.127 (talk) 12:09, 20 January 2011 (UTC)

"Alternative medicines may (illegally) contain very strong steroids"
Sure, they may. But most alternative medicines for eczema probably have no steroids. For example, GLA (gamma-linolenic acid) a fatty acid found in evening primrose oil, black currant oil and borage, is not a steriod. -69.87.204.151 23:48, 2 March 2007 (UTC)

• No right-minded doctor would, I hope, not advocate anything other than using steroids "with care, and only use the minimum necessary, for a minimum time, to get the needed results", but there again is this not an appropriate approach to take with almost all medicines ? Stating that "their proper use can result in atopic dermatitis being brought under control" does not seem unbalanced - it has qualification of "proper use" and only states "control", not of any permanent cure.
• As for alternatives... yes "most ... probably have no steroids", but there again it is probable that most don't work (for if they did and had robust evidence of this then they would be incorporated into conventional medical practice).
  • As the article cites, there have been well reported studies looking into the precise constituents of obtained supposed "pure" TCM (Traditional Chinese Medicine) preparations for eczema, that found potent steroids had been added - of course proposed regulation of herbal supply and manufacture would eliminate such events. Also (real) TCM has not been without its own reported serious systemic effects (see Perharic L, Shaw D, Leon C, De Smet P, Murray V (1995). "Possible association of liver damage with the use of Chinese herbal medicine for skin disease". Vet Hum Toxicol. 37 (6): 562–6. PMID 8588298.{{cite journal}}: CS1 maint: multiple names: authors list (link))
  • As for GLA, why if it is so effective were the UK licenses for prescription items revoked? Answer - because became apparent initial claims for efficacy not subsequently confirmed on review & later studies. See the editorial: "Evening primrose oil for atopic dermatitis -- Time to say goodnight". BMJ. 327: 1358–1359. 2003. doi:10.1136/bmj.327.7428.1358. {{cite journal}}: Unknown parameter |month= ignored (help). Also same reasons for withdrawal in cyclical pre-menstrual breast discomfort in women. [1])
    • Kitz R, Rose M, Schönborn H, Zielen S, Böhles H (2006). "Impact of early dietary gamma-linolenic acid supplementation on atopic eczema in infancy". Pediatr Allergy Immunol. 17 (2): 112–7. PMID 16618360.{{cite journal}}: CS1 maint: multiple names: authors list (link) concludes that "Dietary GLA-supplementation could not prevent AD"
  • re Borage oil, it is ineffective:
    • Henz B, Jablonska S, van de Kerkhof P, Stingl G, Blaszczyk M, Vandervalk P, Veenhuizen R, Muggli R, Raederstorff D (1999). "Double-blind, multicentre analysis of the efficacy of borage oil in patients with atopic eczema". Br J Dermatol. 140 (4): 685–8. PMID 10233322.{{cite journal}}: CS1 maint: multiple names: authors list (link) - concluded that " the overall response to borage oil did not reach statistical significance" and I note the study design description that: "Use of topical diflucortolone-21-valerate cream was allowed as rescue medication,".
    • "Efficacy and tolerability of borage oil in adults and children with atopic eczema: randomised, double blind, placebo controlled, parallel group trial". BMJ. 327: 1385. 2003. {{cite journal}}: Unknown parameter |month= ignored (help) - "Conclusion gamma linolenic acid is not beneficial in atopic dermatitis"
• So, stating the conventional, evidence based treatments in favour of the ineffective alternatives is very much within NPOV guidelines. David Ruben ^Talk 03:15, 3 March 2007 (UTC)

Review

NEJM review http://content.nejm.org/cgi/content/short/358/14/1483 JFW | T@lk 14:43, 6 April 2008 (UTC)

Revised, global nomenclature for allergy

The umbrella term for inflammatory skin reactions is dermatitis, subdivisions are for example contact dermatitis and eczema. Eczema is further subdivided into atopic eczema and non-atopic eczema (depending on IgE levels)

Historically eczema, neurodermitis (neurodermatitis in Engl.) and atopic eczema were used as synonyms. Therefore the article on neurodermatitis should be deleted. A few lines in the atopic eczema article should suffice.

Johansson SG. Revised, global nomenclature for allergy. Unambiguous terms create clarity and prevent misunderstandings. Lakartidningen.2006;103:379-83. (in Swedish) Haddendaddendoedenda (talk) 20:25, 15 February 2009 (UTC)

Amalgam fillings

There is a journal article linked from the Wiki page on Dental amalgam controversy which concerns "The Beneficial Effect of Amalgam Replacement on Health in Patients with Autoimmunity". Article here. Atopic eczema is discussed as one of the disorders that can be affected (albeit, it is the one with the "lowest rate" of improvement). Asat (talk) 20:57, 16 November 2009 (UTC)

Steroid addition

We have this paper but it is not a review Rapaport, MJ (2003 May-Jun). "Corticosteroid addiction and withdrawal in the atopic: the red burning skin syndrome". Clinics in dermatology. 21 (3): 201–14. PMID 12781438. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help) Doc James (talk · contribs · email) 05:17, 9 August 2011 (UTC) What do you mean, "it's not a review?"

Prevention -> Diet --- not referenced / bad reference

Bad reference: 16: "^ a b c . pp. 52–56. doi:10.2340/00015555-0565." ? The doi link goes to a DOI Not Found page.

Not-referenced: The first paragraph of Prevention -> Diet is not cited: "Originally controversial, the association of food allergy with atopic dermatitis has now been clearly demonstrated. Many common food allergens can trigger an allergic reaction: such as milk, nuts, cheese, tomatoes, wheat, yeast, soy, and corn. Many of these allergens are common ingredients in grocery store products (especially corn syrup, which is a sugar substitute). Specialty health food stores often carry products that do not contain common allergens."

I would like to see citations for each of those food items listed relative to atopic dermatitis. Thanks anyone working on this. — Preceding unsigned comment added by 75.97.112.151 (talk) 14:10, 26 August 2011 (UTC)

High-quality, dermatologist-approved moisturizer.

"To combat the severe dryness associated with atopic dermatitis, a high-quality, dermatologist-approved moisturizer should be used daily." I'm not sure what the source for this sentence is. I used to use high-quality, dermatologist-approved moisturizer. After a while I decided it was pretty expensive and tried a form of petroleum jelly (similar ingredients) from sort-of the Dutch equivalent of the dollar store (actually just a store with cheap goods, not everything the same price). Anyway, this stuff is about 10 times as cheap and comparable to the "high-quality, dermatologist-approved moisturizer", at least for me. So I'd like to know the source for this sentence.W3ird N3rd (talk) 04:11, 2 May 2012 (UTC)

I agree its lacking a source. Would suggest that it gets edited to "To combat the severe dryness associated with atopic dermatitis, moisturizer should be used daily." Unifoe (talk) 01:19, 28 October 2012 (UTC)